Respiratory rate at intensive care unit discharge after liver transplant is an independent risk factor for intensive care unit readmission within the same hospital stay: a nested case-control study

Abstract

Purpose: Intensive care unit (ICU) readmission negatively impacts patients' outcomes. We aimed to characterize and determine risk factors for ICU readmission within the initial hospital stay after liver transplant (LT).

Materials and methods: The reference cohort included 369 LT recipients from a Canadian center between 2005 and 2012. One control was randomly selected per each case of ICU readmission within the initial hospital stay after LT. Survival analysis used the Kaplan-Meier method. Associations were studied by conditional logistic regression.

Results: Fifty-two (14%) LT recipients were readmitted to the ICU within the initial hospital stay after LT; they had longer first hospital stay (P < .001) and lower 1-month to 2-year cumulative survival (P < .001). Respiratory failure was the major cause of ICU readmission (61%). Respiratory rate at discharge from the first ICU stay after LT was an independent risk factor for ICU readmission (odds ratio = 1.24). The cutoff point more than 20 breaths per minute prognosticated ICU readmission with a specificity of 90% and a positive predictive value of 80%.

Conclusions: Intensive care unit readmission within the initial hospital stay after LT negatively impacts LT recipients' outcomes. Monitoring respiratory rate at discharge from the first ICU stay after LT is important to prevent readmission.

Keywords: Critical care; Early readmission; Liver transplantation; Predictors.